Inverted Schneiderian Papilloma Research Articles

Transcriptionally Active High-Risk Human Papillomavirus is Not a Common Etiologic Agent in the Malignant Transformation of Inverted Schneiderian Papillomas.

The role of human papillomavirus (HPV) as an etiologic and transformational agent in inverted Schneiderian papilloma (ISP) is unclear. Indeed, reported detection rates of HPV in ISPs range from 0 to 100%. The true incidence has been confounded by a tendency to conflate high- and low-risk HPV types and by the inability to discern biologically relevant from irrelevant HPV infections. The recent development of RNA in situ hybridization for high-risk HPV E6/E7 mRNA now allows the direct visualization of transcriptionally active high-risk HPV in ISP, providing an opportunity to more definitively assess its role in the development and progression of ISPs. We performed p16 immunohistochemistry and high-risk HPV RNA in situ hybridization on 30 benign ISPs, 7 ISPs with dysplasia, 16 ISPs with carcinomatous transformation, and 7 non-keratinizing squamous cell carcinomas (SCCs) with inverted growth that were unassociated with ISP. Transcriptionally active HPV was not detected in any of the 52 ISPs including those that had undergone carcinomatous transformation, but it was detected in two of seven (29%) non-keratinizing SCCs that showed inverted growth. There was a strong correlation between high-risk HPV RNA in situ hybridization and p16 immunohistochemistry (97%; p < 0.01). These results indicate that transcriptionally active high-risk HPV does not play a common role in either the development of ISP or in its transformation into carcinoma.

A suspected case of intranasal inverted Schneiderian papilloma in an adult male from post-Medieval Holland

During the routine assessment of skeletal material unearthed from Middenbeemster, a post-Medieval (AD 17–19th century) cemetery in Northern Holland, an adult male with an unidentified choanal lesion was discovered. The affected individual was analysed macroscopically and via computer tomography. Based on the phenotypic and radiographic characteristics of the lesion, and after a comprehensive review of clinical literature, it was determined that the lesion was likely caused by an inverted Schneiderian papilloma (ISP), a benign but locally aggressive endophytic neoplasm histopathologically characterized by the inversion of the epithelium into the lamina propria (Schneiderian membrane) of the respiratory nasal mucosa. This study presents a detailed description of the pathophysiology and aetiology of ISPs, using both bioarchaeological and biomedical frameworks. Several differential diagnoses are discussed, with emphasis on the reasons for their rejection as the primary pathogenic mechanism(s). To the best of the authors’ knowledge, this research is the first reported case of ISP within palaeopathology, which highlights the need to consider ISPs whenever slow-growing sinonasal neoplasms are suspected, as well as in cases that exhibit focal rhinitis.

Transcriptional Activity of HPV in Inverted Papilloma Demonstrated by In Situ Hybridization of HPV mRNA

Objectives: (1) Demonstrate the incidence of human papillomavirus (HPV) transcriptional activity in inverted Schneiderian papilloma (IP). (2) Evaluate the role of HPV in the pathogenesis of IP and its rare progression to malignancy. (3) Support the consideration of RNAscope in diagnosis and management of IP. Methods: Retrospective clinical and histopathologic review of 20 cases of IP who underwent surgical excision at a tertiary referral center between 1995 and 2013. Surgical pathology archival material was re-examined histopathologically using H&amp;E slides. Formalin-fixed paraffin-embedded material from each case was further evaluated using immunohistochemical staining for p16 as well as in situ hybridization (ISH) for HPV E6/E7 mRNA (RNAscope). Results: Patients were 40% female with average age 53.7 years (range, 23-82 years). Three had evidence of malignancy at the time of excision, and 5 demonstrated recurrence of IP. Average follow-up was 48 months (range, 0-200 months), and one patient died from squamous cell carcinoma (SCC) arising from the IP. HPV transcriptional activity noted by RNAscope within specimens is reported. Conclusions: These data serve to aid in clarification of conflicting prior research attempting to establish a connection between the presence of HPV and development of IP. By demonstrating transcriptional activity of HPV in IP, this connection is rendered more definitive. Further studies are necessary to elucidate the mechanism by which this process occurs, and what, if any, impact HPV status has on progression from IP to SCC.

Nasal papilloma: A comparison between inverted papilloma and oncocytic schneiderian papilloma

The Schneiderian membrane gives rise to 3 morphologically distinct tumours: septal, inverted (IP) and oncocytic schneiderian papillomas (OSP). OSP, although, almost parallel to IP, still have its own distinct features in the incidence, location, clinical presentation and histological examination. Despite the differences, the standard treatment is still surgical removal of the tumour. External approach is preferred but in view of advanced endoscopic technique, it is feasible to remove the tumour endoscopically with carefully selected tumour presentation. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12033 Bangladesh J Otorhinolaryngol 2012; 18(2): 215-218

Papiloma invertido (Papiloma Schneideriano) com envolvimento da cavidade oral: relato de caso incomum

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.

Nasal contact endoscopy for the in vivo diagnosis of inverted schneiderian papilloma and unilateral inflammatory nasal polyps

Inverted schneiderian papilloma is an entity surrounded by controversies ranging from its etiology to the indication of treatment. Any method that permits histopathological analysis without damage to the tissue studied deserves to be investigated. In this study, we tested a new noninvasive method, i.e., nasal contact endoscopy. The main alterations visible on nasal contact endoscopy were described in 11 patients with inverted papilloma and in 8 patients with unilateral inflammatory nasal polyps. The characteristics showing the differentiation between the two entities were defined and these findings were presented to inexperienced examiners. The significant characteristics for differentiation between the two diseases were the presence of vacuolized cells, cellular heterogeneity, cell clusters, a ciliated respiratory epithelium, and vascular patterns. Two of the three examiners showed a statistically significant high rate of correct diagnosis. Nasal contact endoscopy may be an effective method for the differential diagnosis between inverted schneiderian papilloma and inflammatory polyps even when the examiner is inexperienced.

Nasal Contact Endoscopy for thein vivoDiagnosis of Inverted Schneiderian Papilloma and Unilateral Inflammatory Nasal Polyps

BackgroundInverted schneiderian papilloma is an entity surrounded by controversies ranging from its etiology to the indication of treatment. Any method that permits histopathological analysis without damage to the tissue studied deserves to be investigated. In this study, we tested a new noninvasive method, i.e., nasal contact endoscopy.MethodsThe main alterations visible on nasal contact endoscopy were described in 11 patients with inverted papilloma and in 8 patients with unilateral inflammatory nasal polyps. The characteristics showing the differentiation between the two entities were defined and these findings were presented to inexperienced examiners.ResultsThe significant characteristics for differentiation between the two diseases were the presence of vacuolized cells, cellular heterogeneity, cell clusters, a ciliated respiratory epithelium, and vascular patterns. Two of the three examiners showed a statistically significant high rate of correct diagnosis.ConclusionNasal contact endoscopy may be an effective method for the differential diagnosis between inverted schneiderian papilloma and inflammatory polyps even when the examiner is inexperienced.

Pulmonary inverted schneiderian papilloma

Pulmonary inverted Schneiderian papilloma (ISP) is a very rare entity. We herein describe a case that, for its clinical and pathologic features, proved to be challenging.

The inverted Schneiderian papilloma: a 25-year study.

Inverted papillomas arising from the lateral nasal wall are controversial lesions which have been reported in the medical literature under a variety of titles. The designation "inverted Schneiderian papilloma" is recommended as an appropriate title to best convey the tumor's qualities of inversion, location, and distinctiveness of character. The etiology is uncertain. In the absence of a better explanation of its origin, the tumor should be considered a true epithelial neoplasm. Clinical features in 101 cases seen at the Geisinger Medical Center during the past 25 years are presented. The most frequent presenting complaint was nasal obstruction. The site of origin was the lateral nasal wall in the region of the middle meatus. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity, and its propensity to be associated with malignancy. To illustrate the pernicious nature of the lesion, a detailed description is given of the extent of bone erosion, the extraordinary sites of tumor extension, and the perioperative complications encountered. A philosophy of management has evolved based on the experiences gained from these 101 patients combined with a review of the experiences of others and study of the regional anatomy. A bold surgical approach is detailed using a lateral rhinotomy incision or a modified Weber-Ferguson incision to expose the tumor adequately and remove it completely. The recurrence rate using this approach was 2%. An associated malignancy was present in 8 patients. Four died of widespread metastases within a year of the diagnosis. The remaining 4 patients are long-term survivors free of disease.

The inverted Schneiderian papilloma: a clinical and pathological study.

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.